The goal of the study is to determine whether short-term IGF-1 therapy increases lean-body mass and improves nitrogen balance in malnourished hemodialysis patients. The first part of the study involves hospitalization of subjects on the GCRC for an initial baseline and then treatment during which subjects receive a constant metabolic diet and undergo body composition analysis and daily nitrogen balance determinations. Study subjects will continue treatment as outpatients and then return for a shorter GCRC admission for retesting.